Condition
Skin and Soft Tissue Infections
Skin and soft tissue infections are bacterial infections of the skin and the tissue beneath it, where germs such as staph invade and cause redness, swelling and pain. The antibiotics dalbavancin, oritavancin and telavancin have the strongest evidence, with trials finding clinical success in roughly 80 to 88 percent of people, about the same as vancomycin. These drugs matched standard therapy rather than beating it, in trials of acute or complicated infections.
Sources: PMID 26334674; PMID 28480266; PMID 22916113
- Updated
- How we grade
- 100 studies cited
- Supplements studied
- 0
- Medicines and peptides
- 4
- Graded outcomes
- 13
No supplement studies yetWe haven’t found supplement studies for Skin and Soft Tissue Infections. The medicines and peptides studied for it are listed below.
Prescription medicines and peptides studied, for context
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure Rate DISCOVER-1 & DISCOVER-2 pooled (n=1289): Clinical success 79.7% dalbavancin vs 79.8% vancomycin/linezolid (noninferior). Two-dose regimen: 1000 mg day 1, 500 mg day 8. Single-dose 1500 mg also approved. NCT01339091, NCT01431339. | NoneNo effect | 24 studies | ||||
Studies that measured clinical cure rate
| ||||||
| Early Clinical Response (48-72h) ≥20% reduction in lesion area at 48-72h: 83.3% dalbavancin vs 81.8% comparator. Met FDA-required early clinical response endpoint. Among first trials to use new early primary efficacy endpoints. | NoneNo effect | 16 studies | ||||
Studies that measured early clinical response (48-72h)
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| MRSA Efficacy MRSA clinical success comparable to comparator. MIC consistently <0.125 µg/mL against MRSA. Bactericidal against VISA. No cross-resistance with other antibiotic classes. | NoneNo effect | 16 studies | ||||
Studies that measured mrsa efficacy | ||||||
| Nephrotoxicity vs Vancomycin Post-hoc safety analysis: Lower nephrotoxicity rates compared to vancomycin. No renal dose adjustment required for CrCl >30 mL/min. Less monitoring required than vancomycin due to weekly dosing and predictable PK. | Improves (the measure goes down) | Moderate effect | 15 studies | |||
Studies that measured nephrotoxicity vs vancomycin
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| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure - Skin Infections (cSSSI) Pivotal Phase 3 trials (n=902): Clinical success 83.4% daptomycin vs 84.2% conventional therapy (noninferiority met). 4 mg/kg IV once daily for 7-14 days. Effective against MRSA (microbiologic success similar). Noninferior to vancomycin, penicillinase-resistant penicillins. | NoneNo effect | 24 studies | ||||
Studies that measured clinical cure - skin infections (csssi)
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| Myopathy/CPK Elevation SAFETY CONCERN: CPK elevation >5x ULN in 2.8% of patients (vs 1.8% comparators). Myopathy/rhabdomyolysis reported. Weekly CPK monitoring recommended. Discontinue if CPK >1000 U/L with symptoms or >2000 U/L asymptomatic. Avoid concurrent statins when possible. | Worsens (the measure goes down) | Small effect | 18 studies | |||
Studies that measured myopathy/cpk elevation
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| Eosinophilic Pneumonia Risk SAFETY CONCERN: Rare but serious eosinophilic pneumonia reported (onset typically 2-4 weeks). Presents with fever, dyspnea, diffuse infiltrates, eosinophilia. Generally reversible upon discontinuation. Also inactivated by pulmonary surfactant - contraindicated for community-acquired pneumonia. | Worsens (the measure goes up) | Small effect | 19 studies | |||
Studies that measured eosinophilic pneumonia risk
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Oritavancin (Orbactiv)
- Clinical Cure Rate
- Early Clinical Response
- Safety Profile
Telavancin (Vibativ)
- Clinical Cure Rate - cSSSI
- Nephrotoxicity Risk: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Clinical Cure Rate - cSSSI ATLAS-1 & ATLAS-2 Phase 3 (n=1794): Clinical cure rate 88.3% telavancin vs 87.1% vancomycin in clinically evaluable patients. Noninferior to vancomycin for complicated skin and skin structure infections including MRSA. | NoneNo effect | 9 studies | ||||
Studies that measured clinical cure rate - csssi
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| Nephrotoxicity Risk SAFETY CONCERN: Higher mortality in patients with pre-existing renal impairment (CrCl <50 mL/min). Avoid in moderate-severe renal impairment unless benefit outweighs risk. Monitor renal function closely. Dose adjust for CrCl <50. | Worsens (the measure goes up) | Moderate effect | 6 studies | |||
Studies that measured nephrotoxicity risk
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Key findings
- Clinical Cure Rate
- Clinical Cure - Skin Infections (cSSSI)
- Myopathy/CPK ElevationWorsens (the measure goes down)
Safety notes in the studies
- Avoid concurrent statins when possible.
- Pooled safety (n=1959): Adverse events 55.3% vs 56.9% vancomycin.
- No renal toxicity advantage over vancomycin in ABSSSI.
Studies cited
100 studies from PubMed
- Dalbavancin for the treatment of bone and joint infections: A meta-analysis.
- A systematic review of dalbavancin efficacy as a sequential therapy for infective endocarditis.
- Daptomycin-induced pulmonary eosinophilia: early identification of antibiotic side effects.
- Daptomycin treatment for persistent bacteremia in a pediatric solid organ transplant recipient: Case report and literature review.
- Oritavancin a Therapeutic Option for Periprosthetic Joint Infections in Selected Cases: A Comprehensive Review.
- A Comparative Review of the Pharmacology of Dalbavancin and Oritavancin for Gram-Positive Infections: Birds of a Feather or Apples and Oranges?
- Oritavancin for Treatment of Osteomyelitis: A Systematic Review and Meta-Analysis of Observational Studies.
- Safety and Efficacy of Dalbavancin in Real Life: Retrospective Analysis of a Large Monocentric Case Series of Patients Treated for Skin/Soft Tissue and Other Difficult-to-Treat Infections.
- Dalbavancin as long-term treatment in Corynebacterium striatum Infections: a literature review.
- Dalbavancin as suppressive therapy for implant-related infections: a case series with therapeutic drug monitoring and review of the literature.
- Daptomycin Dosage Optimization in Renal Impairment Using Model-Informed Precision Dosing.
- Lipidation Engineering in Daptomycin Biosynthesis.
- Daptomycin-Induced Eosinophilic Pneumonia: A Case Report and Systematic Review.
- Experience with expanded use of oritavancin in a tertiary hospital: indications, tolerability and outcomes.
- Efficacy and Safety of Antibiotics in the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections: A Systematic Review and Network Meta-Analysis.
- Dalbavancin as suppressive antibiotic therapy in patients with prosthetic infections: efficacy and safety.
- Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: a review.
- The current and future off-label uses of dalbavancin: a narrative review.
- Expert Opinion on Dose Regimen and Therapeutic Drug Monitoring for Long-Term Use of Dalbavancin: Expert Review Panel.
- A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections.
- Daptomycin for the treatment of acute bacterial meningitis: A narrative review.
- Daptomycin as an option for lock therapy: a systematic literature review.
- Role of Oritavancin in the Treatment of Infective Endocarditis, Catheter- or Device-Related Infections, Bloodstream Infections, and Bone and Prosthetic Joint Infections in Humans: Narrative Review and Possible Developments.
- The Clinical Efficacy of Multidose Oritavancin: A Systematic Review.
- The role of long-acting antibiotics in the clinical practice: a narrative review.
- Pharmacokinetics and safety of a single dose of telavancin in pediatric subjects 2-17 years of age.
- Acute Bacterial Skin and Skin-Structure Infections, efficacy of Dalbavancin: a systematic review and meta-analysis.
- Dalbavancin treatment for spondylodiscitis: multi-center clinical experience and literature review.
- Dalbavancin as an option for treatment of S. aureus bacteremia (DOTS): study protocol for a phase 2b, multicenter, randomized, open-label clinical trial.
- Efficacy and safety of daptomycin in Japanese pediatric participants with complicated skin and soft tissue infections or bacteremia caused by gram-positive cocci
- Daptomycin synergistic properties from in vitro and in vivo studies: a systematic review.
- Kimyrsa, An Oritavancin-Containing Product: Clinical Study and Review of Properties.
- Safety of dalbavancin in the treatment of acute bacterial skin and skin structure infections (ABSSSI): nephrotoxicity rates compared with vancomycin: a post hoc analysis of three clinical trials
- Stewarding the Costly Antibiotic: Considerations for Dalbavancin.
- Real-World Use of Dalbavancin in the Era of Empowerment of Outpatient Antimicrobial Treatment: A Careful Appraisal Beyond Approved Indications Focusing on Unmet Clinical Needs.
- Efficacy and safety of dalbavancin in the treatment of Gram-positive bacterial infections.
- Review: A Safety Profile of Dalbavancin for On- and Off-Label Utilization.
- Systematic review and meta-analysis on the safety of dalbavancin.
- Dalbavancin treatment for prosthetic joint infections in real-life: a national cohort study and literature review.
- Multiple-Dose Dalbavancin Regimens as the Predominant Treatment of Deep-Seated or Endovascular Infections: A Scoping Review.
- Efficacy and safety of oritavancin for the treatment of acute bacterial skin and skin-structure infections: a systematic review and meta-analysis.
- Telavancin pharmacokinetics in patients with chronic kidney disease receiving haemodialysis.
- Single-dose dalbavancin for acute bacterial skin and skin structure infections
- Dalbavancin and telavancin in the treatment of infective endocarditis: a literature review.
- Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: A randomized clinical trial
- Efficacy and safety of daptomycin: systematic review and meta-analysis
- Glycopeptide Hypersensitivity and Adverse Reactions.
- Treatment of osteoarticular, cardiovascular, intravascular-catheter-related and other complicated infections with dalbavancin and oritavancin: A systematic review.
- Regional analysis of telavancin and comparator antimicrobial activity against multidrug-resistant Staphylococcus aureus collected in the USA 2014-2016.
- Dalbavancin versus standard-of-care for the treatment of osteomyelitis associated with modular mega-prostheses infection: a multicenter prospective randomized study
- Dalbavancin for the Treatment of Osteomyelitis in Adult Patients: A Randomized Clinical Trial of Efficacy and Safety.
- Population pharmacokinetics of daptomycin in critically ill patients with various degrees of renal impairment.
- Daptomycin for the treatment of Staphylococcus aureus infections complicated by septic pulmonary emboli.
- Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review.
- Treatment of chronic osteomyelitis with multidose oritavancin: A case series and literature review.
- Antibiotic penetration into bone and joints: An updated review.
- Renal Dosing of Antibiotics: Are We Jumping the Gun?
- Telavancin-associated acute kidney injury .
- Dalbavancin as a cost effective antibiotic.
- Oritavancin (Orbactiv): a new-generation lipoglycopeptide for the treatment of acute bacterial skin and skin structure infections
- Single intravenous dose of oritavancin for treatment of acute skin and skin structure infections caused by gram-positive bacteria: summary of safety analysis from the phase 3 SOLO studies
- A real-world patient registry for oritavancin demonstrates efficacy and safety consistent with the phase 3 SOLO program
- Developments in Glycopeptide Antibiotics.
- Review of oritavancin for the treatment of acute bacterial skin and skin structure infections.
- Antibiotics.
- Review of the pharmacokinetics of dalbavancin, a recently approved lipoglycopeptide antibiotic.
- Single-Dose Dalbavancin: A Review in Acute Bacterial Skin and Skin Structure Infections.
- Daptomycin for complicated skin infections: a randomized trial
- Daptomycin-Phosphatidylglycerol Domains in Lipid Membranes.
- Efficacy and safety of oritavancin relative to vancomycin for patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting: results from the SOLO clinical trials
- Telavancin: a novel semisynthetic lipoglycopeptide agent to counter the challenge of resistant Gram-positive pathogens
- A comparison of telavancin and vancomycin for treatment of methicillin-resistant Staphylococcus aureus infections: A meta-analysis.
- Safety of Dalbavancin in the Treatment of Skin and Skin Structure Infections: A Pooled Analysis of Randomized, Comparative Studies.
- Possible Hepatotoxicity Associated With Daptomycin: A Case Report and Literature Review.
- Daptomycin Pharmacokinetics and Pharmacodynamics in Septic and Critically Ill Patients.
- Oritavancin: a novel lipoglycopeptide
- Oritavancin: A New Lipoglycopeptide Antibiotic in the Treatment of Gram-Positive Infections.
- Systematic Review and Meta-Analysis of the Efficacy and Safety of Telavancin for Treatment of Infectious Disease: Are We Clearer?
- Dalbavancin: a review in acute bacterial skin and skin structure infections
- Dalbavancin for the treatment of acute bacterial skin and skin structure infections
- Clinical efficacy of dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI)
- Dalbavancin: a novel lipoglycopeptide antibiotic with extended activity against gram-positive infections
- An open-label, pragmatic, randomized controlled clinical trial to evaluate the comparative effectiveness of daptomycin versus vancomycin for the treatment of complicated skin and skin structure infection
- Evaluation of Effectiveness and Safety of High-Dose Daptomycin: Results from Patients Included in the European Cubicin(®) Outcomes Registry and Experience.
- Insights and clinical perspectives of daptomycin resistance in Staphylococcus aureus: A review of the available evidence.
- Single-dose oritavancin versus 7-10 days of vancomycin in the treatment of gram-positive acute bacterial skin and skin structure infections: the SOLO II noninferiority study
- Oritavancin: a review in acute bacterial skin and skin structure infections
- Oritavancin for the treatment of acute bacterial skin and skin structure infections: an evidence-based review.
- Telavancin (VIBATIV) for the treatment of complicated skin and skin structure infections
- Skin and soft-tissue infections: a critical review and the role of telavancin in their treatment.
- Once-weekly dalbavancin versus daily conventional therapy for skin infection
- Daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bacteremia: systematic review and meta-analysis.
- Single-dose oritavancin in the treatment of acute bacterial skin infections
- Renaissance of antibiotics against difficult infections: Focus on oritavancin and new ketolides and quinolones.
- Glycopeptide antibiotics: back to the future.
- Telavancin: a systematic review of the clinical evidence
- Glycopeptide antibiotic biosynthesis.
- Efficacy of telavancin, a lipoglycopeptide antibiotic, in experimental models of Gram-positive infection.
- Safety and efficacy of daptomycin as first-line treatment for complicated skin and soft tissue infections in elderly patients: an open-label, multicentre, randomized phase IIIb trial
- Safety of daptomycin in patients completing more than 14 days of therapy: results from the Cubicin® Outcomes Registry and experience.